<div class="contact-container">
    <div class="v-blank-30"></div>
    <div class="name">
        <div class="icon-box">
            <div class="icon"></div>
        </div>
        <div class="vr"></div>
        <div class="input-box">
            <input class="input" placeholder="请输入您的姓名" name="name">
        </div>
    </div>
    <div class="v-blank-20"></div>
    <div class="phone">
        <div class="icon-box">
            <div class="icon"></div>
        </div>
        <div class="vr"></div>
        <div class="input-box">
            <input class="input" placeholder="请输入您的联系方式" name="phone">
        </div>
    </div>
    <div class="v-blank-20"></div>
    <div class="type-and-sexuality">
        <div class="type">
            <select class="select">
                <option value="0">请选择</option>
                <option value="1">aaaaa</option>
                <option value="2">bbbbb</option>
                <option value="3">bbbbb</option>
                <option value="4">bbbbb</option>
            </select>
        </div>
        <div class="sexuality">
            <div class="h-blank-50"></div>
            <div id="male" class="checked">
                <div class="child"></div>
            </div>
            <div class="h-blank-20"></div>
            <div class="label">男</div>
            <div class="h-blank-50"></div>
            <div id="female" class="default">
                <div class="child"></div>
            </div>
            <div class="h-blank-20"></div>
            <div class="label">女</div>
        </div>
    </div>
    <div class="v-blank-20"></div>
    <div class="description-box">
        <textarea class="input" placeholder="填写详细脱发情况(可选填)，让专家帮您定制专业的脱发治疗方案。" name="detail"></textarea>
    </div>
    <div class="v-blank-20"></div>
    <div class="hint">
        请您核实以上信息无误
    </div>
    <div class="v-blank-20"></div>
    <div class="button-box">
        <div class="button">
            立即预约
        </div>
    </div>
    <div class="v-blank-30"></div>
</div>